Influenza-Related Encephalopathy in Children: Epidemiology and Literature Review from a Tertiary Hospital in Northern Italy (Winter 2023-2024)

Introduction: While influenza-associated encephalopathy (IAE) in children remains a serious concern, recent evidence suggests a shift in its epidemiology, with a possible decline in incidence and severity over time. Methods: This retrospective review includes patients aged 0-18 admitted to a tertiary hospital in Northern Italy between November 2023 and February 2025. Inclusion criteria were a positive influenza test, influenza-like symptoms, and neurological involvement. Findings are interpreted alongside current literature. Results: Twenty-five unvaccinated children met criteria for IAE (11 in 2023/24; 14 in 2024/25). Neurological comorbidities were present in 40%. All patients had pathological EEGs. Lumbar puncture was performed in 40%, with abnormalities in 33%. Brain imaging was conducted in 56% of cases, revealing findings in 15%. All received oseltamivir; 60% were also treated with dexamethasone. Severe complications occurred in 16%, while 12% had persistent symptoms or required therapy at discharge. After adjusting for seasonal peak timing, no significant inter-seasonal difference was observed. Discussion: Although IAE continues to present serious risks, recent trends suggest a changing burden. The lack of vaccination among cases underscores the need for prevention. Study limitations include its single-center design and the absence of long-term follow-up. Broader prospective studies are needed.